HomeMy WebLinkAboutMortgage_Couch'o a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
-°'`'.. •' FOR DEDUCTION FROM ASSESSED VALUATION
` - '
3, � Slate Fortn a3709 (R71 / 6-09)
��'���• Prescnbed by Deparimem of Local Governmen; Fwnte """111��� """999��f �'1
�9!JSTRUCTiONS: �j �g .p 1J File Mark
, �
To be lled in person o� by mail. ji ll �J �--J Form 61e4 wi�h:
Filing Da�es: 1J Real Property: Musf 6e compleled antl dated in 7he ca/entlar year7oi which (he tleduciion is soughf.
Musf be filed wifh (he Counf Auditor or Coun( Recorder ol (he coun[ �'�j� eQr,q�y� �s locatetl ❑ ounry Audi;or
on or 6elore January 5 of (he immediafely suc eeding calendar yeac Y^' '` � V �'u,L County Recorder
2) Mobile / Manulactured Homes not assessed as Real Pmperty: Musf fi/e with !he CountyAuditor o! fhe
county where fhe pmperty is loca[ed dunng the twelve (12) months 6ef�e F3arytjy�ea�h year t6e
dedvction is sought. v \
See �everse side /or additional insWctions and quali�cations. _._.__, _ vr„o
Appficant (owner w con(raG buyer - see res:nctions on 2verse siCe)
Elaine M. Couch
Tau(g DisUitt
Ft. Branch
AssesseG value d real property as ol
March 1. wrten� Year
5135,000.00
If no, whal i5 �i5 / h¢r exatt sliare al
name on recortl is Ciflerent Ihen Ihdt
Key number / legal tlescnpUOn
26-19-18-304-000.741-026
Mortgage / Canvaa inE�
March 1, cuneni year
belOw:
Isaac S. Birch and Sandra L. Birch
Name of mortgagee or conVac� seller
Fifth Third Mortgage Company
AEtlress of rtrorigagee or mntrap seller (number arM sbeet, ciry, slate, and ZlPmtle)
5001 Kingsley Drive, Cincinnati, OH 45227
Name of assignee or other ovmer or holtler of mwtgage
Adaress ol assignce (num0er and sbeet. crty. stare. antl ZIP code)
xs appiicam own properry in any other If yes, what mun.ry?
,wnry in InEiana?
❑ Yes ❑ No
coun
Deauclion apD��etl in Ne artwun� ot
20 20 20 20
Signawre o/ County AuEitor
as
Own¢U wiih SM�leone oiher!tlan 5pOU5e. inditdte wiN wl�Om
20
ilaWe owner?
Yes ❑ No
Is ine properry in ques6on: AnnuallyASSessea
�❑ Real Property ❑ MnualtyASSessed
Mobile Home (IC 61.1
I/ We certify under the penalty o( perjury that the above and foregoing informa6on is We and conect and Uat the
owner / conVac[ buyer o� the aforementioned property on date application is filed.
Signature (owneYs
Fu0 resident adtlress of apdicani (number arM slreel. ary, slate, and ZIP wde)
903 E. Walnut SVeet, FL Branch, IN 47648
Person auUrorized by uuly ezecmetl Pow�er o(Anomey or by IC 61.1-;2-07
of au:horizec person (num0erarM sueel. ary, stare.
on Propem/
n No
of Indiana and
Date (rtronN. tlay, yea�)
04/13/2012
Date (monN, day, year)